UNI Medicare and Health Insurance Agency Producer Information Form/Contract Request

Producer Information Form/Contract Request
Welcome to the Producer Information Form/Contract Request. In just a few short steps you will be providing UNI Health Coverage Agency, LLC DBA UNI Medicare and Health Insurance Agency with the information we need to get your contracting to you. Once delivered, we will follow up to help you along in the process. Thanks!
Agent/Agency Type *

NEW to UNIMedicare and Health Insurance Agency - Requesting first contract EXISTING - Additional contract request

Appointment Type *

Individual Corporation (to be selected by Principals Only) Solicitor (LOA to your upline)
Are you the principal? *

Yes (Principal is LOA to Corporation - commission checks made to corporation) No
Agency Name *
Appointment Type Definitions

Individual: Commission paid direct to the agent

Corporation: Agent contracting as an Agency/Corporation and assigning commission to the Agency/Corporation. This selection is for AGENCY PRINCIPALS ONLY

Solicitor (LOA): Agent employed by upline and assigning commission to the upline